array:24 [ "pii" => "S2387020618305904" "issn" => "23870206" "doi" => "10.1016/j.medcle.2018.12.011" "estado" => "S300" "fechaPublicacion" => "2019-02-15" "aid" => "4487" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2018" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Clin. 2019;152:160-1" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0025775318302227" "issn" => "00257753" "doi" => "10.1016/j.medcli.2018.03.022" "estado" => "S300" "fechaPublicacion" => "2019-02-15" "aid" => "4487" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Clin. 2019;152:160-1" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 27 "formatos" => array:2 [ "HTML" => 17 "PDF" => 10 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científica</span>" "titulo" => "Consumo de la mezcla tabaco-betel-hidróxido cálcico entre estudiantes españoles" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "160" "paginaFinal" => "161" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Consumption of the tobacco-betel-calcium hidroxyde mixture, among Spanish students" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1101 "Ancho" => 1407 "Tamanyo" => 80770 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Distribución en porcentaje del consumo de tabaco en los diferentes grupos (M=mujer; H=hombre).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Nansi López-Valverde, Antonio López-Valverde, Begoña García Cenador" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Nansi" "apellidos" => "López-Valverde" ] 1 => array:2 [ "nombre" => "Antonio" "apellidos" => "López-Valverde" ] 2 => array:2 [ "nombre" => "Begoña" "apellidos" => "García Cenador" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020618305904" "doi" => "10.1016/j.medcle.2018.12.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020618305904?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775318302227?idApp=UINPBA00004N" "url" => "/00257753/0000015200000004/v1_201901310615/S0025775318302227/v1_201901310615/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S2387020619300014" "issn" => "23870206" "doi" => "10.1016/j.medcle.2018.03.040" "estado" => "S300" "fechaPublicacion" => "2019-02-15" "aid" => "4468" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Clin. 2019;152:161-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Methadone dosing in patients on ritonavir-boosted-based highly active antiretroviral therapy" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "161" "paginaFinal" => "162" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dosificación de metadona en pacientes en tratamiento con terapia antirretroviral de gran actividad incluyendo ritonavir" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Roberto Lozano, Nieves Domeque, Alberto Jose Frutos" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Roberto" "apellidos" => "Lozano" ] 1 => array:2 [ "nombre" => "Nieves" "apellidos" => "Domeque" ] 2 => array:2 [ "nombre" => "Alberto Jose" "apellidos" => "Frutos" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020619300014?idApp=UINPBA00004N" "url" => "/23870206/0000015200000004/v1_201902100719/S2387020619300014/v1_201902100719/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2387020618305801" "issn" => "23870206" "doi" => "10.1016/j.medcle.2018.03.039" "estado" => "S300" "fechaPublicacion" => "2019-02-15" "aid" => "4494" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Clin. 2019;152:159-60" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Vogt-Koyanagi-Harada disease: Study of 14 cases" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "159" "paginaFinal" => "160" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Enfermedad de Vogt-Koyanagi-Harada: estudio de 14 casos" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Glenda Espinosa-Barberi, Miguel Ángel Reyes Rodríguez, Félix Francisco Hernández" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Glenda" "apellidos" => "Espinosa-Barberi" ] 1 => array:2 [ "nombre" => "Miguel Ángel" "apellidos" => "Reyes Rodríguez" ] 2 => array:2 [ "nombre" => "Félix Francisco" "apellidos" => "Hernández" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S002577531830229X" "doi" => "10.1016/j.medcli.2018.03.029" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S002577531830229X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020618305801?idApp=UINPBA00004N" "url" => "/23870206/0000015200000004/v1_201902100719/S2387020618305801/v1_201902100719/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Consumption of the tobacco-betel-calcium hydroxide mixture, among Spanish students" "tieneTextoCompleto" => true "saludo" => "Dear Editor" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "160" "paginaFinal" => "161" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Nansi López-Valverde, Antonio López-Valverde, BegoñaGarcía García Cenador" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Nansi" "apellidos" => "López-Valverde" ] 1 => array:4 [ "nombre" => "Antonio" "apellidos" => "López-Valverde" "email" => array:1 [ 0 => "anlopezvalverde@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "BegoñaGarcía" "apellidos" => "García Cenador" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Cirugía, Universidad de Salamanca, Salamanca, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Consumo de la mezcla tabaco-betel-hidróxido cálcico entre estudiantes españoles" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1101 "Ancho" => 1407 "Tamanyo" => 81315 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Percentage distribution of tobacco use in different groups (F, female; M, male).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Smoking is one of the main causes of global mortality, approximately six million people die annually because of this habit, and it is estimated that this figure could increase to ten million by the year 2020.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">There are several ways of consuming tobacco: smoking manufactured cigarettes is the traditional way, but one can also smoke hand-rolled cigarettes made with loose tobacco or consume chewing tobacco. All associated manners of consuming tobacco are associated with different types of cancer.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Multiculturalism and the migratory phenomena both in Spain and in other European Union (EU) countries are giving rise to the host country's population adopting certain habits and customs from immigrants.</p><p id="par0020" class="elsevierStylePara elsevierViewall">A large number of Asian immigrants settled in the central area of Spain, Madrid and the metropolitan area during the economic expansion of the 1990s.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The industrialised areas of Catalonia, the Basque Country, Andalusia and Castilla-León also experienced this type of immigration.</p><p id="par0030" class="elsevierStylePara elsevierViewall">This type of immigration includes citizens from Pakistanis and Northern India, specifically from the region of Punjab, habitual consumers of chewing tobacco. This tobacco is mixed with betel nut, flavouring and calcium hydroxide as an ‘excipient’.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Each ingredient in this blend – except the flavourings (usually cardamom and cinnamon) – are considered carcinogenic. Furthermore, calcium hydroxide could provoke certain types of oral submucosal fibrosis and irritative hyperplasia, which, according to the International Agency for Research on Cancer (IARC), can predispose consumers of these products to certain types of oral carcinomas.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Although in these countries the mixture is sold and consumed pre-prepared, it is easy to prepare oneself, since its components can be easily obtained in Europe. Betel nut, the seed of the betel palm tree, is a low-priced stimulant that can be easily purchased online.</p><p id="par0045" class="elsevierStylePara elsevierViewall">We conducted five surveys in five vocational training centres in the centre, north, south, east and west of Spain, in the cities of Madrid, Bilbao, Seville, Tarragona and Salamanca. A total of 125 male and female students answered the surveys, all of them were students studying Oral Hygiene; there were 25 students per centre and they were aged between 18 and 27.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The survey was totally anonymous and asked participants their sex, age and whether they consumed tobacco – either pre-prepared, a mixture of betel-tobacco or both.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Before requesting the student complete the survey, they were informed of its purpose.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Our study found that in the study population, five males and two females – representing 5.6% of the total sample – consumed the tobacco-betel-calcium hydroxide mixture (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">33% of females and 29% of males aged between 14 and 18 smoke cigarettes in Spain; this figure is one of the highest in the EU.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Nicotine consumed in its traditional form (inhaling cigarette smoke) has been considered a minor cholinergic stimulant; however, ‘smokeless chewing tobacco’ has received little attention in our country, probably due to its low consumption.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Betel nut is the fourth most consumed substance in the world, along with nicotine, ethanol and caffeine. Its nicotinic activity is based on its four main alkaloids: arecoline, arecaidine, guvacolina and guvacina. The combination of tobacco-betel-calcium hydroxide increases risks of morbidity and mortality from oral cancer.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">This preliminary study has shown us that there is a new way of consuming tobacco emerging in Spain, mainly imported from other countries.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Despite the small size of the sample, we believe that the medical and dental consequences of these new methods of consumption mean that carrying out more extensive studies and increasing warning campaigns for potential users is of interest.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: López-Valverde N, López-Valverde A, García Cenador B. Consumo de la mezcla tabaco-betel-hidróxido cálcico entre estudiantes españoles. Med Clin (Barc). 2019;152:160–161.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1101 "Ancho" => 1407 "Tamanyo" => 81315 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Percentage distribution of tobacco use in different groups (F, female; M, male).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mortality from smoking in developed countries 1950–2000, indirect estimation from National Vital Statistics" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R. Peto" 1 => "A.D. Lopez" 2 => "J. Boreham" 3 => "M. Thum" 4 => "C. Heath Jr." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:2 [ "fecha" => "1994" "editorial" => "Oxford University Press" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tobacco carcinogens, their biomarkers, and tobacco-induced cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S.S. Hecht" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/nrc1190" "Revista" => array:6 [ "tituloSerie" => "Nat Rev Cancer" "fecha" => "2003" "volumen" => "3" "paginaInicial" => "733" "paginaFinal" => "744" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14570033" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "comentario" => "Available at: <a class="elsevierStyleInterRef" target="_blank" id="intr0010" href="https://monographs.iarc.fr/ENG/Monographs/vol85/mono85.pdf">https://monographs.iarc.fr/ENG/Monographs/vol85/mono85.pdf</a> [accessed 08.03.18]" "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2004" "editorial" => "International Agency for Research on Cancer, World Health Organization" "editorialLocalizacion" => "Lyon, France" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Further on the causation of oral submucous fibrosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Rajendran" 1 => "A. Karunakaran" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Indian J Dent Res" "fecha" => "2002" "volumen" => "13" "paginaInicial" => "74" "paginaFinal" => "81" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12420571" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Individual, social and environmental determinants of smokeless tobacco and betel quid use amongst adolescents of Karachi: a school-based cross-sectional survey" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Hussain" 1 => "S. Zaheer" 2 => "K. Shafique" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12889-017-4916-1" "Revista" => array:5 [ "tituloSerie" => "BMC Public Health" "fecha" => "2017" "volumen" => "17" "paginaInicial" => "913" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29183302" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015200000004/v1_201902100719/S2387020618305904/v1_201902100719/en/main.assets" "Apartado" => array:4 [ "identificador" => "43311" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015200000004/v1_201902100719/S2387020618305904/v1_201902100719/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020618305904?idApp=UINPBA00004N" ]
Journal Information
Vol. 152. Issue 4.
Pages 160-161 (February 2019)
Share
Download PDF
More article options
Vol. 152. Issue 4.
Pages 160-161 (February 2019)
Scientific letter
Consumption of the tobacco-betel-calcium hydroxide mixture, among Spanish students
Consumo de la mezcla tabaco-betel-hidróxido cálcico entre estudiantes españoles
Visits
5
Nansi López-Valverde, Antonio López-Valverde
, BegoñaGarcía García Cenador
Corresponding author
Departamento de Cirugía, Universidad de Salamanca, Salamanca, Spain
This item has received
Article information
These are the options to access the full texts of the publication Medicina Clínica (English Edition)
Subscriber
Subscribe
Purchase
Contact
Phone for subscriptions and reporting of errors
From Monday to Friday from 9 a.m. to 6 p.m. (GMT + 1) except for the months of July and August which will be from 9 a.m. to 3 p.m.
Calls from Spain
932 415 960
Calls from outside Spain
+34 932 415 960
E-mail